PROVIDING INCLUSIVE HEALTHCARE FOR MARGINALIZED COMMUNITIES

For sex workers in the northern Honduran city of San Pedro Sula, social stigma makes accessing medical and mental health care challenging. Doctors Without Borders/ Médecins Sans Frontières (MSF)’s clinic in the city, which opened in 2021, provides comprehensive care in a supportive environment to sex workers and LGBTQI+ people, who face discrimination when it comes to accessing care.

COURAGE TO SPEAK UP

Nadia, a sex worker in Honduras, has overcome many challenges, including abuse and addiction, from a young age.

“I was out of touch with reality, I was in a messy world, and everything was messed up – my whole body, my health,” she says. But there were few available options for help.

Like women in many parts of the world, Nadia has also faced taboos.

“In our society, a woman’s sexual life should only be active within marriage, and sometimes it is not possible,” says Nadia. “Some stigmatize young people and do not allow them to access prevention services. We should be a little more realistic.”

“In this clinic, I found you can speak openly.”

Nadia says stigma and associated fear can be dangerous. If a woman is afraid to speak up about what she needs in order to have safe sex or if a condom fails and she remains silent, it can prevent her from managing any complications that follow.

“Sometimes we don’t have the opportunity to talk about our sexuality or our fears,” she says. “So, people don’t look for help in time, and can even find death.”

A SAFE SPACE

MSF has sent health promoters into the community to share information about our clinic and make sure sex workers and LGBTQI+ people in San Pedro Sula know they are welcome.

“In this clinic, I found you can speak openly. But there are places where there are health staff whose treatment [of you] is not the same. They are giving you medical attention, but they are also giving you their point of view with what you should or should not do with your life,” Nadia says.

“It has been a blessing to find this place where I can find everything: prevention and control of HIV, syphilis and other sexually transmitted infections, family planning… psychological help and social support.

Mental health is a key part of MSF’s comprehensive care package.

“I realized everything has a price, that taking care of myself was priceless and I began to value that more.”

SELF-CARE

Today, Nadia advocates for mothers and daughters to break through the barriers of social stigma to access services and accurate information.

She says, “Sex education should be available for children of a certain age, and mothers need to allow their daughters to take care of themselves.”

Ruth, also a sex worker in San Pedro Sula, says she believes in self-care: controlling one’s health means being up to date with treatment and coming to the clinic when you feel bad.

Ruth highlights the importance of feeling invited and accepted by a healthcare centre. MSF health promoters have visited Ruth and other women in her neighborhood, explaining the clinic’s doors are open to them, medicine is free and tests are available.

“They told us how to prevent [illnesses], how to take care of ourselves. I felt good,” she says.

Mental health is a key part of MSF’s comprehensive care package.

“When I came to the clinic in the first few days, I did come in quite depressed. I felt that my life no longer made sense. I saw the psychologist because of everything I went through and it has helped me because… it has not been easy,” says Ruth.

To other women, “these beautiful girls,” Ruth says, “my message is to take care of themselves, to protect themselves more than anything, and to be up to date with their [medical] tests and to come for a consultation.”

“And secondly, to support all the women who need it, who are depressed or similar, that’s why the clinic is there and it helps.”

SEXUAL WELL-BEING ACROSS GENERATIONS

“Personally, I suffered too much during the time I didn’t take care of myself,” says Nadia. “I decided and learned through therapy that this is my life, that it is my responsibility, that it is the legacy that I am going to leave to my daughters.

“Sex is beautiful, it is wonderful, it is something that as a fully human being we must enjoy. But to fully enjoy it, you must take care of yourself.”

Nadia draws on her experience to encourage other women: “Dear, educate yourself, take care of yourself so that later you don’t have any trauma, complexes or guilt.”

MSF opened the San Pedro Sula Clinic in July 2021 to offer sexual, reproductive and mental health services to the community and to improve access to care for sex workers and LGBTQI+ people. Located in the centre of the city, the clinic also provides comprehensive care for survivors of sexual violence.